PREDICTION MODEL OF PROBABILITY ESTIMATE OF FATAL CASES IN INFANTS WITH CONGENITAL MALFORMATIONS IN SURGICAL INTERVENTIONS

2021 ◽  
Vol 8 (2) ◽  
pp. 57-61
Author(s):  
Alexey O. Vlasov ◽  
Iryna A. Holovanova
Keyword(s):  
Risk Factors ◽  
Prediction Model ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Anesthesia Care ◽  
Surgical Interventions ◽  
Different Types ◽  
Combined Anesthesia ◽  
Simple Logistic

Aim: To evaluate different types of combined anesthesia in surgical correction of congenital malformations in infants and to develop a prediction model of the association of risk factors and fatal cases in chosen methods of anesthesia care. Material and methods: The retrospective study included newborns and infants with congenital malformations, who received and continued phased surgical treatment. Determination of risk factors was performed by the method of simple logistic regression with the calculation of the odds ratio (OR), 95% confidence interval (95% CI). Results: A total of 150 children were included in the study. The risk factors for deaths in the surgical correction of congenital malformations in children have been established, a prognostic model has been created. Conclusions: To prevent fatal cases in various types of surgery and options for anesthesia care of newborns and infants with CM, it is advisable to more closely monitor the cerebral, peripheral oximetry at all stages of treatment and timely correct the impaired condition of the child.

scholarly journals Analysis of risk factors for different types of anesthetic support of newborns and infants with surgical pathology

2020 ◽  
pp. 28-34
Author(s):  
V.I. Snisar ◽  
◽  
O.O. Vlasov ◽  
I.A. Makedonskyy ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Logistic Regression ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Congenital Malformations ◽  
Fatal Case ◽  
The Body ◽  
Surgical Correction ◽  
Simple Logistic

High-quality anesthetic support during surgical correction of congenital malformations of internal organs and the postoperative period in newborns and infants is complicated by concomitant diseases, significantly affects the processes of metabolism, gas exchange, homeostasis, cerebral, peripheral hemodynamics, etc. before, during and after the surgical intervention. Purpose — to identify the leading risk factors associated with death in various types of anesthetic support for newborns and infants during surgical correction of congenital malformations. Materials and methods. The retrospective study included newborns with congenital malformations of the surgical profile, as well as infants who received and continued stepwise surgical treatment for congenital malformations, depending on the chosen combined anesthetic accompaniment (inhalation + regional anesthesia and inhalation + intravenous anesthesia). The study was carried out in the following stages: 1) to conduct surgical treatment and anesthetic support, 2) introduction of the child into anesthesia, 3) the traumatic stage of the operation, 4) within 1 hour after the operation, 5) 24 hours after the operation. Risk factors were determined by simple logistic regression with the calculation of the odds ratio, 95% confidence interval (95% CI). Results. Among the functional indicators of the vital functions of the body of children with congenital disorders before, during, immediately and 24 hours after surgery against the background of combined anesthesia, with a simple logistic regression analysis, the chance of a fatal case increases with deviations from the norm of peripheral saturation — at all stages of surgical support (7.8–15.0 times); cerebral oxygenation of the child — at the moments of induction into anesthesia and in the postoperative period (10.8 at the stage 2, 72.0 times at the stage 4); increased diastolic blood pressure at the stage of induction of the child into anesthesia (1.6 times). Conclusions. To prevent the chances of death under various types of anesthesia for children with congenital malformations during surgical treatment, it is advisable to more closely monitor blood pressure, cerebral, peripheral oximetry and promptly correct the impaired condition of the child. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: newborns, infants, congenital malformations, anesthesia, risk factors.

STATE OF SYSTEMIC HEMODYNAMICS FOR CHILDREN WITH CONGENITAL SURGICAL PATHOLOGY IN DIFFERENT COMBINED ANESTHESIA TYPES

2021 ◽  
pp. 27-30
Author(s):  
O. O. Vlasov
Keyword(s):  
Blood Pressure ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Systemic Hemodynamics ◽  
Intravenous Anesthesia ◽  
Abdominal Tumors ◽  
Intravenous Drugs ◽  
Different Types ◽  
Combined Anesthesia ◽  
The Impact

General anesthesia for a surgical correction of congenital malformations in children is accompanied, in particular, by the disorders of systemic hemodynamics. In order to assess the impact of different types of combined anesthesia on the state of systemic hemodynamics in surgical correction of congenital malformations, a retrospective study of the treatment of 150 newborns and infants was conducted. These were children with various congenital malformations, but the most common were intestinal obstruction and abdominal tumors. Three groups of patients were formed depending on the type of combined anesthesia during surgical correction of abnormalities: I − inhalation (sevorane) + regional anesthesia; II − inhalation (sevorane) + intravenous anesthesia (fentanyl); III − total intravenous anesthesia with two drugs: analgesic (fentanyl) and drug sleep on the background of intravenous injection of hypnotics (20 % sodium oxybutyrate). There were preformed the surgeries: thoracic, urological, abdominal. The study was retrospectively evaluated in five stages. The analysis of systemic hemodynamics showed a tendency to reduce diastolic blood pressure in children treated with anesthesia with two intravenous drugs (hypnotic and fentanyl), during all observation stages and a significant decrease in this index at the most painful and traumatic period. At the time of induction of anesthesia in children there was a decrease in heart rate. According to the research results, it is concluded that when using the pre−hypnotics as part of combined anesthesia in children with congenital malformations during surgery there is a risk of complications from central hemodynamics in the form of vasodilation, which leads to a drop in blood pressure and increases compensatively the heart contractions. Key words: infants, congenital malformations, anesthesia, hemodynamics.

scholarly journals DIFFERENTIATED APPROACH TO ANESTHETIC MANAGEMENT OF NEWBORNS AND INFANTS WITH SURGICAL PATHOLOGY

2020 ◽  
Vol 10 (4(38)) ◽  
pp. 53-59
Author(s):  
V. Snisar ◽  
A. Vlasov
Keyword(s):  
Logistic Regression ◽  
Surgical Treatment ◽  
Congenital Malformations ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Multiple Logistic Regression Analysis ◽  
Intravenous Anesthesia ◽  
Surgical Interventions ◽  
Combined Anesthesia ◽  
Simple Logistic

Introduction. Various methods of combined anesthesia are used with a combination of inhalation, regional, intravenous anesthesia during surgical interventions in pediatric anesthesiology. It is important to carry out a differentiated approach to the appointment of anesthesia in children at all stages of surgical intervention to prevent complications and deaths in children. Aim. To analyze various types of anesthetic support for newborns and infants with congenital malformations during thoracic, urological and abdominal types of surgical treatment and determine the safest combination of anesthesia. Materials and methods. The retrospective study included newborns with congenital malformations of the surgical profile, as well as infants who received and continued stepwise surgical treatment for congenital malformations, depending on the chosen combined anesthetic accompaniment (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous one). After identification and assessment of 41 prognostic variables by simple logistic regression with the calculation of the odds ratio, stepwise multiple logistic regression analysis was performed to identify significant factors associated with death. Results. It has been proven that there is no relationship between the age of children, the type of surgical intervention in newborns and infants with congenital malformations with various options for anesthesiological support and deaths. It can be argued that the combination anesthesia options selected for analysis are safe. Conclusions. To prevent the chances of fatalities in various types of surgical interventions and options for anesthetic support of newborns and infants with congenital malformations, it is advisable to monitor blood pressure (especially diastolic), cerebral, peripheral oximetry at all stages of treatment more closely and correct the impaired condition of a child in time.

scholarly journals Efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children

2020 ◽  
pp. 43-51
Author(s):  
A. M. Karamyshev ◽  
G. V. Ilukevich ◽  
T. V. Lyzikova
Keyword(s):  
Congenital Malformations ◽  
Early Postoperative Period ◽  
Surgical Correction ◽  
Laryngeal Mask ◽  
Anesthetic Technique ◽  
Urogenital System ◽  
Inhalation Anesthesia ◽  
Combined Anesthesia ◽  
Group 2 ◽  
Caudal Blockade

Objective: to assess the efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children by means of the performance of the comparative analysis of perioperative adverse events and complications, consumption of the inhalation anesthetic sevoflurane and the cost of anesthesia, and also the course of the early postoperative period. Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with 0.25% bupivacaine solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of 0.25% bupivacaine solution and adjuvant (group 3, n = 45). Results. The performed analysis has not revealed any statistically significant distinctions in the assessment of anesthesia complications but it has found some significant distinctions in the consumption of sevoflurane, depth of anesthesia and its cost, as well as the necessity for postoperative anesthesia and introduction of analgesics, which testifies to the efficiency and safety of combined anesthesia and its economic benefit. Conclusion. The most effective, safe, and economically reasonable is the technique of combined anesthesia with the application of caudal blockade with local anesthetic solution and 0.1% adjuvant of morphine solution during surgical correction of congenital malformations of the lower parts of the urogenital system in children.

Exploratory Laparotomy for Necrotizing Enterocolitis

2018 ◽  
Author(s):  
Karla E. K. Wyatt ◽  
Olutoyin A. Olutoye
Keyword(s):  
Risk Factors ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Exploratory Laparotomy ◽  
Anesthesia Care ◽  
Comorbid Conditions ◽  
Surgical Interventions ◽  
Pediatric Anesthesiologist ◽  
Inflammatory Bowel

Necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that commonly affects premature infants. The pathogenesis is multifactorial and poorly understood, although certain risk factors have been identified. This disease, more commonly detected in premature infants with accompanying cardiac and pulmonary comorbid conditions, is associated with increased morbidity and mortality. Multiorgan system homeostasis becomes critical for the pediatric anesthesiologist when approaching medical and surgical interventions for affected patients. This chapter focuses on the population at risk for developing necrotizing enterocolitis, medical and surgical management, providing anesthesia care in the neonatal intensive care unit, as well as perioperative considerations and complications.

scholarly journals Comparative evaluation of different types of anesthesia in surgical treatment of children with congenital defects

2021 ◽  
Vol 26 (1) ◽  
pp. 115-121
Author(s):  
О.О. Vlasov
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Surgical Treatment ◽  
Predictive Model ◽  
Regional Anesthesia ◽  
Surgical Intervention ◽  
Congenital Defects ◽  
Intravenous Anesthesia ◽  
Surgical Interventions ◽  
Combined Anesthesia

In pediatric anesthesiology in surgical interventions various methods of combined anesthesia with a combination of inhalation, regional, and intravenous anesthesia are used. The provision of high-quality anesthetic support in newborns and infants during surgical treatment of congenital defects is complicated by risk factors, concomitant diseases and different pathology conditions. The study of risk factors and their influence on the functional indices of the child's vital activity in prescribing anesthesia at all stages of the surgical intervention will help prevent complications and deaths in children. Aim – to сonduct a comparative assessment of various types of anesthesia for surgical correction of congenital defects in children and create a predictive model of the association of risk factors and deaths in the selected methods of anesthetic support. The retrospective study included 150 newborns and infants with congenital defects of the surgical profile depending on anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). After identifying and evaluating prognostic variables by simple logistic regression with calculating the odds ratio, stepwise multiple logistic regression analysis was performed and a predictive model of the association of risk factors and deaths with various types of anesthetic management was created. In thoracic operations a combined anesthesia with sevoran and fentanyl was most often used – 20.4%. In abdominal operations, in total anesthetic support with sevoran and regional anesthesia was used– 69.4%, while in urological operations combined total intravenous anesthesia with 2 drugs – 18.4% ranked first. No significant diffe­ren­ces were found between the types of anesthesia in various surgical interventions for congenital pathologies, between the types of surgery and deaths (p = 0.863). To prevent fatalities in various types of surgical intervention and options for anesthetic support of newborns and infants with congenital defects, it is advisable to more closely monitor the cerebral and peripheral oximetry indicators at all stages of treatment and timely correct the impaired condition of the child.

scholarly journals Major Types of Parahtyroid Glands Location and Their Relationship with the Post-Operative Hypoparathyroidism

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Andriy Pasko
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Thyroid Gland ◽  
Visual Assessment ◽  
Node Dissection ◽  
Peripheral Lymph Node ◽  
Surgical Interventions ◽  
Peripheral Lymph ◽  
Almost All

We have performed 130 operations on the thyroid gland. The spectrum of surgical interventions on the thyroid gland was as follows: hemithyroidectomy was performed for 49.2% of patients, thyroidectomy – for 23.1% of patients and thyroidectomy with central and peripheral lymph node dissection – for 27.7% of patients. All patients were performed the determination of PTG type and their visual assessment.Types A and B1 are rarely traumatized during operations on thyroid gland, PTG of type B2 and B3, C practically in almost all cases are damaged or become ischemic in a varying degree, therefore, types B2, B3 and C can be considered as the risk factors for the development of postoperative HPT, and in case of type B2 of PTG they were technically difficult to be isolated without damage, and in the B3 and C types it is generally difficult to keep them intact. Determination of the type of PTG and their visual assessment is the basis for solution to the problem of preservation of PTG in place or of their autotransplantation

scholarly journals Analysis the Safety and Efficacy at Different Types of Anesthesiological Support During Aesthetic Interventions on the Breast Glands in Ukraine

2021 ◽  
Vol 14 (4) ◽  
pp. 2109-2121
Author(s):  
Iurii Kuchyn ◽  
Dmytro Sazhyn ◽  
Gennadiy Patlazhan
Keyword(s):  
Postoperative Nausea ◽  
Mammary Glands ◽  
Inhalation Anesthesia ◽  
Cognitive Score ◽  
Surgical Interventions ◽  
Individual Assessment ◽  
Combined Use ◽  
Different Types ◽  
Combined Anesthesia ◽  
The Individual

The aim is to learn the features of aesthetic and reduction surgical interventions on the mammary glands in Ukraine. Materials and methods. The study was conducted by analyzing the inpatient ambulatory cards of 320 patients. Anesthesia was provided by propofol (n=130), sevoflurane (n=140) and combined use of sevoflurane and nalbuphine (n=50). The results of the study. It was found that usage of combined inhalation analgesia of sevoflurane with opioids was characterized by 41.9% less recovery time. It was found that 8 hours after surgery, the individual assessment of pain was lower in the group of combined analgesia with opioids relative to intravenous anesthesia with propofol (87.5%, p<0.05) and inhalation anesthesia with sevoflurane (71, 3%, p<0.05). After 24 hours all patients reported about pain below 1.0 point, however, in groups where sevoflurane and nalbuphine were used, the level of pain self-esteem was 2.61 and 3 times lower than after intravenous propofol. It was found that within 1 hour after surgery, the average cognitive score on the Montreal scale decreased in the group of intravenous propofol by 5.0% (p<0.05) and by 1.7% under inhalation anesthesia with sevoflurane. Under combined anesthesia the cognitive score remained at 12.0 points. The frequency of postoperative nausea was the highest level in the group of inhalation anesthesia - 16.7%. The addition of nalbuphine to sevoflurane significantly reduced the risk of postoperative nausea (χ2=7.250; p=0.007). Conclusions. Combined anesthesia with opioids is a highly effective anesthetic choice for aesthetic and reconstructive interventions on the mammary glands.

scholarly journals Analysis of vital indicators for different types of anesthesia in newborns and infants with surgical pathology

2020 ◽  
Vol 24 (4) ◽  
pp. 595-599
Author(s):  
O. O. Vlasov
Keyword(s):  
Regional Anesthesia ◽  
Surgical Pathology ◽  
Organ Function ◽  
Intravenous Anesthesia ◽  
Surgical Interventions ◽  
Group Iii ◽  
Vital Functions ◽  
Group I ◽  
Different Types ◽  
Combined Anesthesia

Annotation. In newborns and infants, surgical interventions against the background of severe concomitant and background perinatal pathologies and malformations lead to catabolic stress, circulatory and respiratory disorders, which are reflected in the indicators of vital functions. Given the high risk of severe complications of organ function in the perioperative and postoperative periods, it is advisable to continuously monitor key clinical parameters. Aim of the study – to establish the absolute values of indicators of vital functions in newborns and infants with congenital surgical pathology with various types of combined anesthesia and compare them with clinical data. A retrospective study included 150 newborns and infants with congenital malformations of the surgical profile, depending on the anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). The parameters of peripheral oximetry, blood pressure, heart rate and respiration were analyzed. It was found that peripheral saturation did not critically decrease at all stages of observation. With the exception of the resulting decrease in the indicator in children of group I compared with group III at the stage of induction into anesthesia (97.79±2.45 versus 98.79±1.63, at p=0.0194, respectively) and at the most painful moment of surgical intervention (96.29±3.47 versus 98.10±2.47, with p=0.0368). In children who received combined intravenous anesthesia with two drugs, there was an increase in mean arterial pressure from the beginning of surgical treatment to the child's recovery after surgery (49.49±10.71, 56.18±8.05, respectively, at p˂0.01). Thus, among the surveyed groups, the most vulnerable were children for whom anesthesia was provided by Sevoflurane inhalation with regional anesthesia. The performed correlation analysis established the effect of anesthesia on the general hemodynamics in children during all stages of observation.

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